Beal EW, Bennett SC, Whitson BA, Elkhammas EA, Henry ML, Black SM. Caval reconstruction techniques in orthotopic liver transplantation. World J Surg Proced 2015; 5(1): 41-57 [DOI: 10.5412/wjsp.v5.i1.41]
Corresponding Author of This Article
Sylvester M Black, MD, PhD, Department of Surgery, the Ohio State University Wexner Medical Center, 395 W 12th Ave, Suite 150, Columbus, OH 43210-1267, United States. sylvester.black@osumc.edu
Research Domain of This Article
Transplantation
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Surg Proced. Mar 28, 2015; 5(1): 41-57 Published online Mar 28, 2015. doi: 10.5412/wjsp.v5.i1.41
Caval reconstruction techniques in orthotopic liver transplantation
Eliza W Beal, Shaylyn C Bennett, Bryan A Whitson, Elmahdi A Elkhammas, Mitchell L Henry, Sylvester M Black
Eliza W Beal, Shaylyn C Bennett, Bryan A Whitson, Elmahdi A Elkhammas, Mitchell L Henry, Sylvester M Black, Department of Surgery, the Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
Bryan A Whitson, Division of Cardiothoracic Surgery, Department of Surgery, the Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
Elmahdi A Elkhammas, Mitchell L Henry, Sylvester M Black, Division of Transplantation Surgery, Department of Surgery, the Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
Author contributions: Beal EW involved in the drafting, editing and design of the manuscript; Black SM involved in the conception, design and revision of the manuscript; Bennett SC, Whitson BA, Elkhammas EA and Henry ML contributed equally to the conception, review and revision of the manuscript.
Conflict-of-interest: All authors declare that they have no commercial, personal, political, intellectual or religious interests in relation to the submitted work.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sylvester M Black, MD, PhD, Department of Surgery, the Ohio State University Wexner Medical Center, 395 W 12th Ave, Suite 150, Columbus, OH 43210-1267, United States. sylvester.black@osumc.edu
Telephone: +1-614-2933212 Fax: +1-614-2936720
Received: September 29, 2014 Peer-review started: September 29, 2014 First decision: January 8, 2015 Revised: January 28, 2015 Accepted: February 10, 2015 Article in press: February 12, 2015 Published online: March 28, 2015 Processing time: 185 Days and 13.4 Hours
Abstract
There are several caval reconstruction techniques currently in use for orthotopic liver transplantation. These include caval replacement or the conventional technique, performed with or without venovenous bypass, piggyback technique with anastomosis with two or three hepatic veins with or without cavotomy and modifications of the piggyback technique including end-to-side and side-to-side cavocaval anastomosis. There are few randomized controlled trials comparing the use of these techniques and our knowledge of their comparability is based on a few multi- and many single-center retrospective and prospective reviews. Although there are advantages and disadvantages for each technique, it is advisable that the surgeon perform the technique with which they have the most the experience and at which they are the most skilled as excellent outcomes can be obtained with any of the caval reconstruction options discussed.
Core tip: There are multiple options available for caval reconstruction currently in use for orthotopic liver transplantation. Those options include caval replacement or the conventional technique, performed with or without venovenous bypass, piggyback technique with anastomosis with two or three hepatic veins with or without cavotomy and modifications of the piggyback technique including end-to-side and side-to-side cavocaval anastomosis. There is currently no consensus in regards to the best technique although there are advantages and disadvantages for each. Excellent outcomes can be obtained with any of the described techniques and the surgeon’s comfort and skill with the technique is likely the most important factor.
